Abstract Title Surgical Outcomes of Fresh Frozen Cartilage Use in Rhinoplasty: A Systematic Review

Background Despite high satisfaction rates, rhinoplasty has a 5-15% revision rate, which is often complicated by insufficient cartilage. This challenge can be addressed with the use of cartilage grafts, including autologous cartilage and irradiated homologous costal cartilage. Recently, fresh frozen costal cartilage (FFCC) has emerged as a promising alternative, providing reduced donor site morbidity and preserved biomechanical properties. The purpose of this review is to systematically synthesize the existing literature on FFCC for rhinoplasty, focusing on surgical outcomes to inform clinicians and guide future research.

Methods A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search input, “(fresh frozen) AND (rhinoplasty)” was utilized to identify relevant articles in six electronic databases: Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Google Scholar, PubMed, Scopus, and Web of Science. Database searching yielded 83 records. Three independent reviewers screened and assessed identified articles based on pre-established eligibility criteria. Eligible studies reported original patient outcomes of rhinoplasty utilizing FFCC and provided sufficient data regarding outcomes. Extracted data included study design, patient demographics, technical details, and surgical outcomes.

Results A total of five studies were included in the review, and collectively encompassed data for a total of 766 patients (83.9% female, 16.1% male) who underwent rhinoplasty with FFCC. This included 72 primary rhinoplasties (9.4%) and 694 revision procedures (90.6%). Across the 766 patients, there were 13 cases (1.7%) of infection, nine cases (1.2%) of warping and seven cases (0.9%) of cartilage resorption. Of studies reporting cartilage graft displacement, there was only one case (0.1%). Additionally, the reoperation rate ranged from 0.5% to 16% with an average of 2.3% (n=18) across the studies.

Conclusion With comparable outcomes and low complication and reoperation rates, FFCC represents a safe and reliable alternative to autologous rib grafts for rhinoplasty. However, given the novelty of this technique, additional studies with larger patient populations and long-term follow-up are needed to validate these findings.